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【Objective】 To study the correlation between platelet transfusion efficacy and KIR receptor-HLA ligand. 【Methods】 Thirty-three leukemia patients with positive HLA antibody were tested for cross-matching with donor platelets. Platelets from suitable donors were selected for transfusion, and the 24-hour platelet corrected count increment (CCI) was used to determine the transfusion effect. KIR and ligand genotyping were performed on blood samples from patients and donors by PCR-SSP method, and the relationship between platelet transfusion effects and KIR receptor-HLA ligand was analyzed. 【Results】 In 74 occasions of platelet transfusion, 42 were ineffective and 32 were effective. When the donor had C2 gene and HLA-B Bw4-80T gene, the frequency of ineffective platelet transfusion in the recipient was 69.0% (29/42) and 52.4% (22/35), respectively, which was significantly higher than that in the effective group [25.0% (8/32) and 25.0% (8/32)]. When the donor had C1 gene, and the frequency of effective platelet transfusion in the recipient was 100.0%(32/32), which was higher than that in the ineffective group [83.3%(35/42)]. When the recipient-donor matching mode was KIR2DL1-C2 and KIR3DL1-(HLA-B Bw4-80T), the frequency of ineffective platelet transfusion was 69.0%(29/42) and 40.5%(22/42),higher than that of the effective group [25% (8/32) and 18.8% (6/32)]. When the recipient-donor matching model was KIR2DL3-C1, the rate of effective platelet transfusion in 32 patients (100.0%), which was higher than that (35 patients 83. 3%) in the ineffective group. When the mismatch mode of recipient iKIR+donor HLA ligand receptor was KIR2DL1-C2, the frequency of effective platelet transfusion in the recipient was 78.1% (25/32), which was much higher than that in the ineffective group [31.0% (13/42)]. When the mismatch mode was KIR3DL1-(HLA-B Bw4-80T), the rate of effective platelet transfusion in the recipient was 68.8% (22/32), which was higher than that in the ineffective group (42.9%, 18/42). The difference between the above groups was statistically significant(P<0.05). 【Conclusion】 HLA-C1 and HLA-C2 genes are the key factors affecting the efficacy of platelet transfusion.For platelet refractorines, HLA-C1 is the protective gene, while HLA-C2 and HLA-B Bw4-80T are the susceptible genes. The recipient iKIR+donor HLA ligand receptor model may play an important role in platelet refractoriness.
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Objective@#To compare the clinical features, ultrasonic imaging manifestations and therapeutic evaluations between elderly onset rheumatoid arthritis (EORA) and EORA with osteoarthritis (OA).@*Methods@#Eighty-eight patients with rheumatoid arthritis were divided into two groups: group EORA (n=36) and group EORA+OA (n=52). The onset age of all patients was 60 years or older. General conditions, joint involvement distribution, ultrasonic manifestations and disease activity scores (DAS28-3) of patients in the two groups were analyzed. The χ2 test/Fisher's exact probability test and the Student's t test/Mann-Whitney U test were used to analyze data.@*Results@#There was no significant difference in the proportion of male and female patients and erythrocyte sedimentation rate (ESR) between the two groups (P>0.05). The onset age of patients in group EORA+OA [(68±4) years old] was higher than that in group EORA [(65±4) years old], and the difference was statistically significant (t=-3.465, P=0.001). Duration of the disease and body mass index in group EORA+OA were significantly higher respectively than those in group EORA. Joint involvement in the two groups was mainly found in shoulder, wrist, Metacarpophalangeal joint (MCP)2, MCP3, proximal inter-phalangeal joint (PIP)2, PIP3, PIP4, and knee joint (34.7%-86.5%). The percentage of MCP2[36.5%(38/104), 70.8%(51/72); χ2=20.02, P<0.01], MCP3[33.7%(35/104), 59.7%(43/72); χ2=11.72, P=0.001], MCP4[4.8%(5/104), 22.2%(16/72); χ2=12.28, P<0.01], PIP2[69.2%(72/104), 83.3%(60/72); χ2=4.51, P=0.034] and PIP3[53.8%(56/104), 70.8%(51/72); χ2=5.15, P=0.023] in the EORA+OA group was lower while the percentage of MCP1, DIP 2, DIP3, DIP4 and knee joints were higher than that in the EORA group (P<0.05). In group EORA+OA, the synovial thickness of the wrist joints [(4.2±0.5) mm] and knee joints [(7.7±0.8) mm] were significantly thicker than those in group EORA [(3.2±0.9) mm; (6.3±0.8) mm, t=-5.82, P<0.01; t=-7.22, P<0.01]; The proportion (70.0%) of level 2 and 3 of patients' wrist joint synovium pannus blood flow and knee joint synovium pannus in group EORA+OA were increased than group EORA (51.9%; 52.3%), the difference between the two groups was statistically significant (χ2=4.64, P=0.031; χ2=4.43, P=0.035). There was no significant difference in DAS28-3 scores between the two groups before patients received treatment. After 2 weeks and 12 weeks of glucocorticoid treatment, DAS28-3 scores in group EORA [3.62(2.88, 4.03); 2.35(2.26, 2.62) points] were significantly lower than group EORA+OA [5.01(4.68, 5.26); 3.38(2.28, 3.83) points] (Z=-7.766, P<0.01; Z=-3.461, P<0.01).@*Conclusion@#Compared with patients of EORA alone, patients of EORA with OA have more obvious joint symptoms, MCP1, DIP and knee joint are susceptible to the co-involvement among them, longer duration of disease, and were prone to synovial hyperplasia and pannus flow formation. The therapeutic effects of glucocorticoid on joint inflammation in patients of EORA alone are superior to those patients of EORA with OA.
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Objective To compare the clinical features,ultrasonic imaging manifestations and therapeutic evaluations between elderly onset rheumatoid arthritis (EORA) and EORA with osteoarthritis (OA).Methods Eighty-eight patients with rheumatoid arthritis were divided into two groups:group EORA (n=36)and group EORA+OA (n=52).The onset age of all patients was 60 years or older.General conditions,joint involvement distribution,ultrasonic manifestations and disease activity scores (DAS28-3) of patients in the two groups were analyzed.The x2 test/Fisher's exact probability test and the Student's t test/Mann-Whitney U test were used to analyze data.Results There was no significant difference in the proportion of male and female patients and erythrocyte sedimentation rate (ESR) between the two groups (P＞0.05).The onset age of patients in group EORA+OA [(68±4) years old] was higher than that in group EORA [(65±4) years old],and the difference was statistically significant (t=-3.465,P=0.001).Duration of the disease and body mass index in group EORA+OA were significantly higher respectively than those in group EORA.Joint involvement in the two groups was mainly found in shoulder,wrist,Metacarpophalangeal joint (MCP)2,MCP3,proximal interphalangeal joint (PIP)2,PIP3,PIP4,and knee joint (34.7％-86.5％).The percentage of MCP2 [36.5％(38/104),70.8％ (51/72);x2 =20.02,P ＜0.01],MCP3 [33.7％ (35/100),59.7％ (43/72);x2 =11.72,P =0.001],MCP4 [4.8％ (5/100),22.2％ (16/72);x2 =12.28,P＜0.01],PIP2 [69.2％ (72/104),83.3％ (60/72);x2 =4.51,P=0.034]and PIP3 [53.8％(56/100),70.8％(51/72);x2=5.15,P=0.023] in the EORA+OA group was lower while the percentage of MCP1,DIP 2,DIP3,DIP4 and knee joints were higher than that in the EORA group (P＜0.05).In group EORA+OA,the synovial thickness of the wrist joints [(4.2±0.5) mm] and knee joints [(7.7±0.8) mm]were significantly thicker than those in group EORA [(3.2±0.9) mm;(6.3±0.8) mm,t=-5.82,P＜0.01;t=-7.22,P＜0.01];The proportion (70.0％) of level 2 and 3 of patients' wrist joint synovium pannus blood flow and knee joint synovium pannus in group EORA+OA were increased than group EORA (51.9％;52.3％),the difference between the two groups was statistically significant (x2=4.64,P=0.031;x2=4.43,P=0.035).There was no significant difference in DAS28-3 scores between the two groups before patients received treatment.After 2 weeks and 12 weeks of glucocorticoid treatment,DAS28-3 scores in group EORA [3.62 (2.88,4.03);2.35 (2.26,2.62) points] were significantly lower than group EORA+OA [5.01(4.68,5.26);3.38(2.28,3.83) points](Z=-7.766,P＜0.01;Z=-3.461,P＜0.01).Conclusion Compared with patients of EORA alone,patients of EORA with OA have more obvious joint symptoms,MCP1,DIP and knee joint are susceptible to the coinvolvement among them,longer duration of disease,and were prone to synovial hyperplasia and pannus flow formation.The therapeutic effects of glucocorticoid on joint inflammation in patients of EORA alone are superior to those patients of EORA with OA.
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Objective Idiopathic pulmonary fibrosis, the fibrosis score (i.e., the combined extent of reticulation and honeycombing) is associated with worse survival. The aim of this study was to identify high-resolution computed tomography (HRCT) patterns and patient characteristics that could predict poor prognosis in rheumatoid arthritis-related ILD (RA-ILD). Methods We retrospectively analyzed 130 patients with newly diagnosed RA-ILD from 2011 to 2017 at Shanxi People's Hospital. The Pearson correlation analysis was used for the correlation between the fibrosis score and the worse survival of RA-ILD, and Using Cox regression analysis was used to identify the associations with mortality. A value of P less than 0.05 was considered statistically significant. Results During a median follow-up of 65 months, 32/130 (24.6％) patients died. Univariate analysis identified 6 significant poor prognostic factors: lower baseline ％ predicted forced vital capacity [HR=0.97, 95％CI(0.94, 0.99);P=0.008], total interstitial disease score [HR=1.06, 95％CI(1.03, 1.08);P<0.01], reticulation score [HR=1.07, 95％CI (1.04, 1.09); P<0.01], traction bronchiectasis score [HR=2.04, 95％CI (1.21, 3.40);P=0.008], fibrosis score [HR=1.07, 95％CI (1.01, 1.13);P<0.01], and definite UIP pattern [HR=4.18, 95％CI (1.40, 12.51); P=0.010]. Fibrosis score remained to be an independent significant poor prognostic factor of survival on bivariate analysis [HR=8.136, 95％CI (2.87, 28.35); P=0.001]. Patients with a fibrosis score>20％ had high mortality. Conclusion This study has shown that fibrosis score is strongly associated with worse survival in RA-ILD, and patients with fibrosis score>20％ have a 8.136-fold increased risk of mortality.